Now that the Supreme Court has ruled ObamaCare's individual mandate constitutional, the direction of American health policy is in the hands of voters. So how do we get from here to "repeal and replace"?

Step one is electing Mitt Romney as president, along with Republican House and Senate majorities. Without a Republican sweep, the law will remain in place.

But a President Romney does not need 60 Republican senators to repeal core elements of ObamaCare. Democrats lost their 60th senate vote in early 2010 after Scott Brown took Edward Kennedy's seat. To bypass a Senate GOP filibuster and enact portions of ObamaCare, they used a special legislative procedure called reconciliation.

Reconciliation allows a bill to pass the Senate in a limited time period, with limited amendments, and with only 51 votes; filibusters are not permitted. In 2010, Democrats split their health-policy changes into two bills, one of which they enacted through this fast-track process. In 2013, a Republican majority could use the same reconciliation process to repeal those changes.

The reconciliation process, however, applies only to legislative changes to taxes, spending and debt, or the change must be a "necessary term or condition" of another provision that affects taxes or spending.

Crucial parts of ObamaCare meet this test. Thus, if a President Romney has cohesive and coordinated majorities in the House and Senate, a reconciliation bill could repeal the Affordable Care Act's Medicaid expansion, insurance premium and drug subsidies, tax increases (all 21 or them), Medicare and Medicaid spending cuts, its long-term care insurance program known as the Class Act, and its Independent Payment Advisory Board, a 15-member central committee with vast powers to control health-care and health markets.

Chief Justice John Roberts ruled that the financial penalty enforcing the individual mandate is within Congress's constitutional power to "lay and collect Taxes," and that the mandate and penalty are inextricably linked. This should suffice to enable repeal, through reconciliation, of both the individual and employer mandates, and their respective penalty taxes.

The state exchanges and insurance rules—"guaranteed issue," which forces an insurer to sell a policy to someone who is already sick, and "community rating," which severely limits the insurer's right to charge that person a higher premium—are procedurally more difficult. Yet both are linked to the individual mandate, which increases taxes. Whether they can be repealed in a reconciliation bill will ultimately be decided by the Senate Parliamentarian.

Once the individual mandate is repealed, these popular insurance changes cannot stand by themselves. Without the mandate, people have every incentive to save on premiums and not buy insurance until they fall ill. This will send premiums through the roof for healthy people and, if the government clamps down on increased premiums, destroy private insurance companies. Those Republicans who say they favor legislated guaranteed-issue and community-rating requirements but oppose the mandate will be forced to acknowledge that all three must go.

Repealing core parts of ObamaCare cannot take place immediately. The opportunity to use a reconciliation bill requires first passing a budget resolution, something the Senate Democratic majority has not done in three years. This, too can be done with simple majorities, but realistically it would take until April to pass a budget resolution, and to enact a repeal through reconciliation in May.

The president and his allies argue that ObamaCare reduced the deficit, and that repealing it would mean a deficit increase. That claim was always laughable. In any event, the Congressional Budget Office is now re-estimating the effect of repeal on spending, taxes and deficits in anticipation of an upcoming House vote, scheduled for next week. Repeal may look fiscally more attractive in coming days than it did two years ago. If the new CBO estimate concludes that repeal would increase the deficit, then those favoring repeal will just have to make more spending cuts. Given the size and rate of growth of government spending, it's not that hard to do.

Repeal and replacement should be separate legislative efforts. This will allow more opportunities to create bipartisan center-right coalitions. Future Republican majorities can work with moderate Democrats to enact needed insurance market reforms and the bipartisan Wyden-Ryan Medicare reform plan, which provides a stronger system of competing private health plans as opposed to government-run "fee-for-service" Medicare.

Piecemeal reform does not mean incremental reform. The pre-ObamaCare status quo is unsustainable and unacceptable, and a President Romney and his allies must be as bold in their pursuit of consumer-driven health reform as President Obama was in his pursuit of government control.

Reform should start by replacing the tax exclusion for employer-provided health insurance with a flat tax deduction or credit. This should be combined with insurance reforms that allow consumers to buy portable health insurance sold anywhere in the nation, through their employer or on their own. That means you'll be able to take your health insurance with you from one job to the next. Tax policy will no longer push Americans toward lower wages in favor of more expensive health insurance.

Top it all off with expanded contribution limits for health savings accounts, aggressive national medical liability reform, and structural Medicare and Medicaid reforms that dramatically slow the growth of government and deficits.

In 2009 and 2010 the nation took huge steps down a path toward more government control of health care. A shift to the consumer-based reform path is still available—if voters want it.

Hennessey was NEC director under Bush, and so probably had a big hand in the 2006 or so Bush health care reform proposal. This was a really smart and well-designed plan and unfortunately it got pretty much ignored because Bush was so unpopular at the time. You get a short take on it in the last 3 paragraphs.

mnchiefsguy

07-04-2012, 02:16 PM

Sounds good...but if Romney does not start calling the mandate a tax, and campaign hard on this point, it will all be for naught, as he will not be sitting in the White House.

patteeu

07-04-2012, 02:34 PM

Sounds good...but if Romney does not start calling the mandate a tax, and campaign hard on this point, it will all be for naught, as he will not be sitting in the White House.

I don't think his campaign hinges on whether or not he calls the mandate a tax. Besides, if he really agrees that it's a tax, he should probably agree that Obamacare is constitutional (unless he has a sophisticated argument about why it's an impermissible tax).

In any event, he's come out and accepted the court's determination that it's a tax today, in the same way GWBush accepted the court's determination that Habeas Corpus extends to Gitmo (meaning he accepts the decision even if he doesn't agree with it).

mnchiefsguy

07-04-2012, 02:40 PM

I don't think his campaign hinges on whether or not he calls the mandate a tax. Besides, if he really agrees that it's a tax, he should probably agree that Obamacare is constitutional (unless he has a sophisticated argument about why it's an impermissible tax).

In any event, he's come out and accepted the court's determination that it's a tax today, in the same way GWBush accepted the court's determination that Habeas Corpus extends to Gitmo (meaning he accepts the decision even if he doesn't agree with it).

The Romney camp has sounded almost like Obama lite with how fast they have agreed with the administration that it is a "mandate", not a tax. Sounding like Obama is not going to get Romney elected.

mlyonsd

07-04-2012, 02:47 PM

Romney: Insurance mandate is a tax, high court 'has spoken'

Published July 04, 2012
FoxNews.com

Mitt Romney on Wednesday made another attempt at clarifying his view of the recent Supreme Court decision on President Obama’s health-care reform law, saying the punishment for failing to purchase insurance is a tax – not a penalty fine.

The GOP presidential candidate said he agreed with the minority of justices in the 5-4 decision that the punishment is a fine, but “the Supreme Court has spoken.”

“The majority of the court said it’s a tax, therefore it’s a tax,” Romney said in a CBS News interview. “They have spoken. There’s no way around that. … The American people (now) know that President Obama has broken the pledge he made. He said he wouldn’t raise taxes on middle-income Americans.”

Romney’s comments follow top campaign adviser Eric Fehrnstrom saying Monday the candidate thinks the consequence for not purchasing mandated insurance is a penalty. Fehrnstrom said that position is the same one Romney took on a similar fine under the statewide health-care initiative he instituted as Massachusetts governor.

Fehrnstrom’s statement was a departure from House Speaker John Boehner and other Republican leaders who have, since the high court’s decision Thursday, gotten behind the majority ruling, an election-year attempt to pin a tax increase on the president.

GOP leaders also have said congressional Democrats up for reelection this fall will have a hard time defending the law now that its central provision is, according to the court, a tax.

Romney’s comments Wednesday in fact mark the second time in three days that the campaign has attempted to clarify its position.

Hours after Fehrnstrom’s comment, the campaign issued a statement saying Romney considers the fine an “unconstitutional penalty” rather than a tax.

The Romney camp has sounded almost like Obama lite with how fast they have agreed with the administration that it is a "mandate", not a tax. Sounding like Obama is not going to get Romney elected.

He remained consistent that it was a mandate because his position was that a mandate was unconstitutional. (Everyone agrees that Obamacare could have breezed through constitutional challenges if it had been explicitly fashioned as a tax.) That's why, from his pov, it was OK at the state level but not OK when Obama did it at the federal level. But that doesn't mean that he doesn't see it as a hidden tax as well.

I just don't think this matters much. People who base their vote this November on Obamacare are going to vote for Romney if they don't like it (no matter what he says about the mandate) and they're going to vote for Obama if they want it to remain the law of the land.

mnchiefsguy

07-04-2012, 04:44 PM

He remained consistent that it was a mandate because his position was that a mandate was unconstitutional. (Everyone agrees that Obamacare could have breezed through constitutional challenges if it had been explicitly fashioned as a tax.) That's why, from his pov, it was OK at the state level but not OK when Obama did it at the federal level. But that doesn't mean that he doesn't see it as a hidden tax as well.

I just don't think this matters much. People who base their vote this November on Obamacare are going to vote for Romney if they don't like it (no matter what he says about the mandate) and they're going to vote for Obama if they want it to remain the law of the land.

Probably true, although it appears that Romney is now starting to refer to it as a tax (which is good, I think once people realize what a tax burden this creates, their opinion of it will change):

The Romney camp has sounded almost like Obama lite with how fast they have agreed with the administration that it is a "mandate", not a tax. Sounding like Obama is not going to get Romney elected.

Someone pointed out to me that this is an indication Romney doesn't really want to repeal the bill.
I thought it was a valid point.

RedNeckRaider

07-04-2012, 06:10 PM

The Romney camp has sounded almost like Obama lite with how fast they have agreed with the administration that it is a "mandate", not a tax. Sounding like Obama is not going to get Romney elected.

The price of being a flip flop. This will be the most disappointing vote I have ever cast~

Ace Gunner

07-04-2012, 06:24 PM

HCF, you must be a pothead. The powers that be have been working this country over for damn near fifty years. You can pipe dream, most americans have been throughout the course of this calculated downward spiral designed to take out the constitution, but the corporatist gov't won't change course.

RedNeckRaider

07-04-2012, 06:33 PM

HCF, you must be a pothead. The powers that be have been working this country over for damn near fifty years. You can pipe dream, most americans have been throughout the course of this calculated downward spiral designed to take out the constitution, but the corporatist gov't won't change course.
Sadly this post is on the money. The right sells Mayberry and the left sells spread the money around and we can all have wealth. Both side continue to further protect themselves and those special interest groups who own them~

cosmo20002

07-04-2012, 09:49 PM

Romney: Insurance mandate is a tax, high court 'has spoken'

Published July 04, 2012
FoxNews.com

Mitt Romney on Wednesday made another attempt at clarifying his view of the recent Supreme Court decision on President Obama’s health-care reform law, saying the punishment for failing to purchase insurance is a tax – not a penalty fine.

I haven't seen anyone tie themselves into a pretzel this much trying to explain themselves on so many issues since the last guy the Rs nominated for Pres.

Setsuna

07-04-2012, 11:13 PM

I haven't seen anyone tie themselves into a pretzel this much trying to explain themselves on so many issues since the last guy the Rs nominated for Pres.

Who cares. Anyone is better than your boy Obama at this point.

mnchiefsguy

07-05-2012, 12:49 AM

Who cares. Anyone is better than your boy Obama at this point.

Sadly, this appears to be the case.

Pawnmower

07-05-2012, 12:51 AM

Who cares. Anyone is better than your boy Obama at this point.

I thought the same thing until all of these lies and attacking his own plan....

Now I am really not so sure about that.....

Maybe theyre the same person?

mlyonsd

07-05-2012, 08:07 AM

I haven't seen anyone tie themselves into a pretzel this much trying to explain themselves on so many issues since the last guy the Rs nominated for Pres.Well other than your guy tying himself into a pretzel and lying about not raising taxes on the middle class like he already did.

Iz Zat Chew

07-05-2012, 09:01 AM

The powers that be have been working this country over for damn near fifty years.

Unfortunately that statement is true. It's also true that the "powers that be" are not elected officials. Our current president is more of an empty suit than anyone we've had in the past 50 years.

Amnorix

07-05-2012, 09:09 AM

Sounds good...but if Romney does not start calling the mandate a tax, and campaign hard on this point, it will all be for naught, as he will not be sitting in the White House.

You're nuts if you think this election will be decided by Obamacare.

Iz Zat Chew

07-05-2012, 09:53 AM

You're nuts if you think this election will be decided by Obamacare.

There is plenty that Obama has done to lose the election. If he doesn't lose we are fooked as a country. Can you spell bankruptcy?

“”If you thought it was a good idea for the federal government to go in this direction, I’d say the odds are still on your side,” said McConnell, “because it’s a lot harder to undo something than it is to stop it in the first place.”

Now we know why Republicans never repeal anything. Much Republican unity will be necessary for this to happen and we can't count on it. Boehner needs to be dealt with as well. Gingrich betrayed behind closed doors earlier. Rand Paul is countering these these big Establishment guys on this. If the Republicans lose their spine—they will be doomed as a party. If this is repealed such an action would make history.

Let's make history. Bombard congress with faxes, emails, letters and calls.

www.humanevents.com/2012/07/04/the-education-blob/

BucEyedPea

07-05-2012, 09:58 AM

There is plenty that Obama has done to lose the election. If he doesn't lose we are fooked as a country. Can you spell bankruptcy?

O b a m a r e - e l e c t i o n

We're already bankrupt. Obamcare should be linked to the economy, which it is but it needs to be juxtaposed that way to the public.

qabbaan

07-05-2012, 09:59 AM

Reconciliation was an extremely underhanded way of ramming this bill through, in addition to all the other back room deals and payoffs. I see nothing wrong with using reconciliation in this case only, to remove or gut a harmful piece of legislation that was only passed by reconciliation. The Democrat party escalated things to the nuclear option, as it were, so they can't really complain about it.
Posted via Mobile Device

“”If you thought it was a good idea for the federal government to go in this direction, I’d say the odds are still on your side,” said McConnell, “because it’s a lot harder to undo something than it is to stop it in the first place.”

Now we know why Republicans never repeal anything. Much Republican unity will be necessary for this to happen and we can't count on it. Boehner needs to be dealt with as well. Gingrich betrayed behind closed doors earlier. Rand Paul is countering these these big Establishment guys on this. If the Republicans lose their spine—they will be doomed as a party. If this is repealed such an action would make history.

Let's make history. Bombard congress with faxes, emails, letters and calls.

www.humanevents.com/2012/07/04/the-education-blob/

wouldn't a mass petition from the public be a direction to take?

BucEyedPea

07-05-2012, 10:11 AM

wouldn't a mass petition from the public be a direction to take?

This is ongoing right now. Get to work. It's up to us to impose our will now. Don't believe what they just say.

mnchiefsguy

07-05-2012, 10:18 AM

You're nuts if you think this election will be decided by Obamacare.

Will it be decided by Obamacare? No. But Romney needs show why he would be the better choice, and sounding like Obama and agreeing with the "mandate" are not going to help. "Obama Lite" will not get the job done.

The economy will decide the election. In order for Romney to win, he has to convince the public that their bottom line will be better with him in the White House. If people do not buy into that, then Obama will get another term.

BucEyedPea

07-05-2012, 10:28 AM

Will it be decided by Obamacare? No. But Romney needs show why he would be the better choice, and sounding like Obama and agreeing with the "mandate" are not going to help. "Obama Lite" will not get the job done.

The economy will decide the election. In order for Romney to win, he has to convince the public that their bottom line will be better with him in the White House. If people do not buy into that, then Obama will get another term.

I think it will be a factor since more oppose it and want it repealed. It's moved me over to considering Romney instead of voting Johnson or 3 Party.

Setsuna

07-05-2012, 10:32 AM

I thought the same thing until all of these lies and attacking his own plan....

Now I am really not so sure about that.....

Maybe theyre the same person?

That is a strong case you present, but if anything, a Republic majority in Congress should keep him politically loyal to the party.

BucEyedPea

07-05-2012, 10:35 AM

That is a strong case you present, but if anything, a Republic majority in Congress should keep him politically loyal to the party.

Not necessarily. The historic pattern for Republicans is that they tend to vote more liberal if they have a RINO as president. Witness what happened under Bush. They don't like to make their party guy look bad so they go along to get along. It's naive to think otherwise. The heat has to be kept on the Republicans constantly, so that they actually do impose their will if they have their guy in office.

Setsuna

07-05-2012, 10:42 AM

Not necessarily. The historic pattern for Republicans is that they tend to vote more liberal if they have a RINO as president. Witness what happened under Bush. They don't like to make their party guy look bad so they go along to get along. It's naive to think otherwise. The heat has to be kept on the Republicans constantly, so that they actually do impose their will if they have their guy in office.

Ok so what will this "heat" entail? I'm curious.

Amnorix

07-05-2012, 10:54 AM

Will it be decided by Obamacare? No. But Romney needs show why he would be the better choice, and sounding like Obama and agreeing with the "mandate" are not going to help. "Obama Lite" will not get the job done.

Romney has very little credibility to undermine Obama on the health care reform front. His involvement in Massachusetts cuts his legs out from under him. The Republicans chose to nominate the ONE GUY that really can't attack Obama on health care.

Also, what is he going to do, promise repeal? He can't. It won't happen, and he knows it. Heck, they've already half-admitted it.

The economy will decide the election. In order for Romney to win, he has to convince the public that their bottom line will be better with him in the White House. If people do not buy into that, then Obama will get another term.

Yes, the economy is where it's at, not foreign policy, and not Obamacare.

Johnny Vegas

07-05-2012, 10:55 AM

This is ongoing right now. Get to work. It's up to us to impose our will now. Don't believe what they just say.

I didn't even know one was started. I found a link to a petition. Pretty sure this is the one I want to sign as its got millions of signatures.

http://repealhealthcareact.org/

BucEyedPea

07-05-2012, 10:58 AM

I didn't even know one was started. I found a link to a petition. Pretty sure this is the one I want to sign as its got millions of signatures.

http://repealhealthcareact.org/

You can do that one if you want. There's a bunch. But a personal fax, email or letter is much better. Follow up with a call. They've backed down on a few things recently....so it can be done. Keep it short and respectful.

Bachmann's even selling bumper stickers on a site for its repeal.

KC native

07-05-2012, 10:59 AM

The economy will decide the election. In order for Romney to win, he has to convince the public that their bottom line will be better with him in the White House. If people do not buy into that, then Obama will get another term.

Not going to happen. The gop picked the candidate that allows Obama to rely on the 99% argument. The ads decrying his private equity background are already showing up and hurting romney across the midwest. Now that the report about how much romney actually has off shore in tax havens, look for even more decimating ads. Romney is Kerry part 2.

BucEyedPea

07-05-2012, 11:16 AM

Ok so what will this "heat" entail? I'm curious.

"will" requires I know the future. All I'm saying is that the congress needs to feel pressure or heat, if you will, on them on how people feel about repealing it. So write to them and let your position be known and that you'd like a response on where they stand. Do it whether your rep is an R, D or I. Get them publically on record regarding their vote.

Remember all those calls they got on immigration and sopa....those helped. They're not an end all because they slip some of these things back in as amendments to larger bills.

But you can do something about it.

Iz Zat Chew

07-05-2012, 03:01 PM

Also, what is he going to do, promise repeal? He can't. It won't happen, and he knows it. Heck, they've already half-admitted it.

If he can't repeal it he can at least write an executive order that the whole act be reviewed and cleaned up to be an honest reform act rather than the abortion we have now.

There are too many wormholes for government intrusion into private lives as it stands. It's also the one largest tax increase ever levied on the U.S. in history.

The worst part of the new tax is that we currently can't afford what we are doing now, how in hell are we going to tack another trillion dollars onto the ever deepening debt?

HonestChieffan

07-05-2012, 03:44 PM

Not going to happen. The gop picked the candidate that allows Obama to rely on the 99% argument. The ads decrying his private equity background are already showing up and hurting romney across the midwest. Now that the report about how much romney actually has off shore in tax havens, look for even more decimating ads. Romney is Kerry part 2.